Relative production of IL-1 beta and TNF alpha by mononuclear cells after exposure to dental implants

Immunomodulatory Effects Mediated by Nano Amorphous Calcium Phosphate/Chitosan Oligosaccharide Lactate Coatings Decorated with Selenium on Titanium Implants

The aim of this work is in situ anodization/anaphoretic deposition of a nano amorphous calcium phosphate (ACP)/chitosan oligosaccharide lactate (ChOL) multifunctional hybrid coating decorated with selenium (Se) on a titanium substrate and in vivo investigation of its immunomodulatory and anti-inflammatory effect. Investigating phenomena at the implant-tissue interface of interest for controlled inflammation and immunomodulation was also the aim of the research. In our earlier research, we designed coatings based on ACP and ChOL on titanium with anticorrosive, antibacterial and biocompatible properties, while in the presented results we show that selenium addition makes this coating an immunomodulator. The immunomodulatory effect of the novel hybrid coating is characterized by the examination of the functional aspects in the tissue around the implant (in vivo): proinflammatory cytokines' gene expression, M1 (iNOS) and M2 (Arg1) macrophages, fibrous capsule formation (TGF-β) and vascularization (VEGF). The EDS, FTIR and XRD analyses prove the formation of a ACP/ChOL/Se multifunctional hybrid coating on Ti and the presence of Se. A higher M2/M1 macrophage ratio in the ACP/ChOL/Se-coated implants compared to pure titanium implants (a higher level of Arg1 expression) is noted at all time points examined (after 7, 14 and 28 days). Lower inflammation measured by gene expression of proinflammatory cytokines IL-1β and TNF, lower expression of TGF-β in the surrounding tissue and higher IL-6 expression (solely at day 7 post-implantation) is noted in presence of the ACP/ChOL/Se-coated implants.

Do Titanium Dioxide Particles Stimulate Macrophages to Release Proinflammatory Cytokines and Increase the Risk for Peri-implantitis?

PURPOSE

Titanium dioxide (TiO₂) particles detached from titanium dental implants by tribocorrosion can be phagocytosed by macrophages, releasing various proinflammatory cytokines at the implant sites that may trigger peri-implantitis. The study objective was to measure the association between peri-implantitis and the presence of non-allergy-related proinflammatory cytokines associated with TiO₂ particles.

METHODS

The investigators implemented a retrospective cross-sectional study and enrolled a sample of 60 subjects from a dental practice. Subjects were excluded if the plaque index was grade 3 (Silness and Löe). The predictor variable was a positive or negative TiO₂ stimulation test, an in vitro macrophage proinflammatory response test. The outcome variable was peri-implantitis status defined as present or absent. Three groups were considered: control group with 20 patients without dental implants (group 1), 2 groups of patients with titanium dental implants, one without peri-implantitis (group 2), and the other with peri-implantitis (group 3) (n = 20 each). For patients with implants, depth of the gingival pockets of the implants were measured, and existing bleeding and suppuration were determined to assess peri-implantitis. Radiographs were taken if one or more factors applied to confirm the diagnosis of peri-implantitis. Further covariates were age, sex, duration of implant wear, and number of implants which were analyzed descriptively. Inferential analyses were undertaken using χ² test, Kruskal-Wallis-, Wilcoxon-two-sample tests, and logistic regressions.

RESULTS

The sample was composed of 35 female and 25 male patients with a mean age of 54.2 years (standard deviation = 14.76). The overall TiO₂ stimulation test positivity frequency was 28.3% and were 30.0%, 5.0%, and 50.0% in the control, implants without peri-implantitis, and implants with peri-implantitis groups. No statistically significant differences could be seen in the frequencies of the TiO₂ stimulation test results between control group and combined groups 2 and 3 (P-value = .84). The risk for positive TiO₂ patients with a titanium implant of developing peri-implantitis was statistically significant and higher compared to negative TiO₂ patients (odds ratio, 19.0 with 95% confidence interval [2.12,170.38]; P-value< .01).

CONCLUSIONS

The data in this study showed a statistically significant relationship between a positive TiO₂ stimulation test and peri-implantitis. Further studies with larger numbers of subjects are recommended to confirm this result.

Association of interleukin-1 gene polymorphism and early crestal bone loss around submerged dental implants: A systematic review and meta-analysis

Aim:

Early crestal bone loss (ECBL) has been observed regardless of the absence of possible etiologic factors for bone loss during the healing phase and before the second-stage implant surgery. The purpose of this systematic review and meta-analysis was to correlate the possible association of interleukin-1 (IL-1) gene polymorphisms and ECBL (bone loss before the second-stage surgery) around dental implants.

Settings and Design:

Systematic review and meta-analysis following PRISMA guidelines.

Materials and Methods:

Considering the inclusion criteria, an electronic search by using specific keywords of three databases PubMed [(“Dental” OR “oral”) AND (“Implants*”) AND (“gene polymorphism” OR “genotype” AND (“IL-1” OR “interleukins”)], Cochrane library [implant AND (biomarker or cytokine), interleukin-1 or IL-1 AND implants], and EMBASE [(“gene polymorphisms”/de OR “interleukins”/cytokine exp OR “biomarker”:ti,ab,kw) AND (“dental implantation”/de OR “oral implant”)] and manual search from 1995 till March 2020 was made by 2 independently calibrated reviewers. ACROBAT-NRSI, Version 1.0.0 and Review Manager, Version 5.3, computer software were used for the risk of bias assessment and to conduct the meta-analysis respectively.

Statistical Analysis Used:

Cochran's Q test and I² statistics.

Results:

Of 38 articles which were found eligible for full-text screening, two articles fulfilled the inclusion criteria and hence were included in the meta-analysis. The I² statistic and Q-test values of the included studies revealed acceptable homogeneity for studied three IL-1 gene polymorphisms (IL-1A−889: I² =0%, IL-1B − 511: I² = 0%, IL-1B+3954: I² = 24%). Forest plot of association between IL-1B−511 gene and ECBL revealed a significant association between 2/2 genotype of IL-1B−511 gene and an increased risk of ECBL (OR = 0.23, 95% CI = 0.09–0.58, P_{heterogeneity}= 0.68, I² = 0%, and P = 0.002). Results of the IL-1A−889 and IL-1B+3954 gene revealed no significant associations between any genotype of these genes with risk of ECBL.

Conclusions:

There is an evidence of the association of IL-1B−511 (2/2) genetic polymorphisms and increased ECBL in the individuals of Asian ethnicity (OR = 0.23, P = 0.002).

Titanium implants and silent inflammation in jawbone-a critical interplay of dissolved titanium particles and cytokines TNF-α and RANTES/CCL5 on overall health?

BACKGROUND AND INTRODUCTION

It is a well-known fact that titanium particles deriving from dental titanium implants (DTI) dissolve into the surrounding bone. Although titanium (TI) is regarded as a compatible implant material, increasing concern is coming up that the dissolved titanium particles induce inflammatory reactions around the implant. Specifically, the inflammatory cytokine tumor necrosis factor-alpha (TNF-α) is expressed in the adjacent bone. The transition from TNF-α-induced local inflammation following insertion of DTI surgery to a chronic stage of "silent inflammation" could be a neglected cause of unexplained medical conditions.

MATERIAL AND METHODS

The signaling pathways involved in the induction of cytokine release were analyzed by multiplex analysis. We examined samples of jawbone (JB) for seven cytokines in two groups: specimens from 14 patients were analyzed in areas of DTI for particle-mediated release of cytokines. Each of the adjacent to DTI tissue samples showed clinically fatty degenerated and osteonecrotic medullary changes in the JB (FDOJ). Specimens from 19 patients were of healthy JB. In five cases, we measured the concentration of dissolved Ti particles by spectrometry.

RESULTS

All DTI-FDOJ samples showed RANTES/CCL5 (R/C) as the only extremely overexpressed cytokine. DTI-FDOJ cohort showed a 30-fold mean overexpression of R/C as compared with a control cohort of 19 healthy JB samples. Concentration of dissolved Ti particles in DTI-FDOJ was 30-fold higher than an estimated maximum of 1.000 μg/kg.

DISCUSSION

As R/C is discussed in the literature as a possible contributor to inflammatory diseases, the here-presented research examines the question of whether common DTI may provoke the development of chronic inflammation in the jawbone in an impaired state of healing. Such changes in areas of the JB may lead to hyperactivated signaling pathways of TNF-α induced R/C overexpression, and result in unrecognized sources of silent inflammation. This may contribute to disease patterns like rheumatic arthritis, multiple sclerosis, and other systemic-inflammatory diseases, which is widely discussed in scientific papers.

CONCLUSION

From a systemic perspective, we recommend that more attention be paid to the cytokine cross-talk that is provoked by dissolved Ti particles from DTI in medicine and dentistry. This may contribute to further development of personalized strategies in preventive medicine.

Peri-implant crestal bone loss: a putative mechanism

Purpose. The immunological mechanisms of peri-implant crestal bone loss have, hitherto, not been elucidated. We hypothesized that bacterial products from the microgap cause upregulation of cytokines in otherwise healthy peri-implant cells, which results in osteoclast formation and, ultimately, in bone resorption. Materials and Methods. We used RT-PCR and ELISA to assay mediators of osteoclastogenesis in rat and human macrophages (r-and hMO); bone marrow derived stromal cells (r-and hBMCs); and human gingival fibroblasts (hGF)—with or without stimulation by LPS. TRAP positive multinucleate cells were assessed for their resorptive ability. Results. We show that IL-1α, IL-1β, and IL-6 were expressed by all examined cell types, and TNF-α was upregulated in hGF. Secretion of IL-1α and IL-1β proteins was stimulated in hMO by LPS, and IL-6 protein secretion was highly stimulated in hBMCs and hGF. Both LPS and RANKL stimulated macrophages to form osteoclast-like TRAP positive cells, which resorbed calcium phosphate substrates. Conclusion. Taken together, the results of our study support the hypothesis that bacterial endotoxins upregulate enhanced mediators of osteoclastogenesis in resident cells found in the healthy peri-implant compartment and that the local synergistic action of cytokines secreted by such cells results in the genesis of resorptively active osteoclasts.

Surface contamination of dental implants assessed by gene expression analysis in a whole-blood in vitro assay: a preliminary study

AIM

We aimed at evaluating pyrogen contamination of dental implants made of titanium and zirconia by using gene expression analysis in a whole-blood in vitro assay.

MATERIAL AND METHODS

Titanium and zirconia implants (five each) were incubated in human whole blood. Samples were assayed for gene expression levels of toll-like receptor 4 (TLR4), TLR9, interleukin (IL)-1β, nuclear factor 'kappa-light-chain-enhancer' of activated B-cells (NF-kB), tumour necrosis factor (TNF)-α, and Fas-associated protein with death domain (FADD) as indicators of surface contamination resulting in lipopolysaccharides (LPS)-stimulated TLR- or TNF-mediated immune responses. Gene expression was assayed using real-time quantitative polymerase chain reaction (RT-qPCR). Non-stimulated blood from the same donor served as a negative control, and blood stimulated with LPS served as a positive control. After dry-heat treatment with dry heat, all implants were re-analysed as described above.

RESULTS

Both implant systems contained surface contaminants evoking a pro-inflammatory response similar to that induced by LPS. After dry-heat treatment, gene expression was significantly decreased to levels similar to those of negative control samples.

CONCLUSIONS

The results demonstrated LPS-like surface-bound contaminants in both tested implant systems. Depyrogenation with dry heat seems to be an effective means of reducing such contamination in dental implants.

An evaluation of biocompatibility of indigenously produced pure titanium: an experimental study in rabbits

The indigenously produced pure titanium dental implants are economical and useful for common human use in India. The aim of this study is to test the biocompatibility of the indigenously produced pure titanium dental implant material obtained from the Defense Metallurgical Research Laboratory, Hyderabad, India, and the Institute of Nuclear Medicine and Allied Science, Delhi, India. An experimental study in rabbits was done to study the amount of ordered bone formation around the screw and cylinder type of indigenously produced pure titanium metal implant specimens. The experimental animals were killed at 4, 6, 8, 12, and 16 weeks from the date of implantation. The histopathological examination of the animals killed at 16 weeks demonstrates the presence of osteoblastic cell proliferation and early ordered bone formation toward the implant site, indicating signs of osseointegration of both screw- and cylinder-type indigenously produced pure titanium specimens.

A split-mouth study on microbiological profile in clinical healthy teeth and implants related to key inflammatory mediators

This split-mouth study investigated the correlation of the qualitative and quantitative bacterial composition in dental plaque around clinically healthy periodontal and peri-implant subgingival sites with the levels of selected pro- and anti-inflammatory cytokines and the inflammatory infiltrate in the soft tissue surrounding a healthy dental implant and natural tooth in the same patient. Nine patients, all in good health and non-smokers, were studied. All of the patients were highly motivated in terms of oral hygiene and had healthy natural teeth and at least one healthy implant. After three sessions of professional oral care, clinical parameters were recorded. A sample of subgingival plaque was harvested with a sterile curette from the buccal side of the selected implants and teeth. The plaque samples were cultured to quantify the total microbiota and the number of obligate and facultative bacterial strains. Simultaneously, from the lingual/palatal aspect of the same implants and teeth the keratinized periodontal and peri-implant soft tissues were biopsied for cytokine expression and histomorphometric analysis. The tissue biopsies were halved: the real-time reverse transcriptase-polymerase chain reaction (PCR) was performed to detect active TNF-alpha, IL-1beta, IL-8, and TGF-beta2 and distribution, composition, quantification of inflammation were assessed in parallel. The patients harbored no periodontopathogens and the microbiological composition of the plaque taken from implant sites did not differ from that harvested from teeth. No significant differences were seen between implants and teeth for both proand anti-inflammatory cytokines. Even the histological examination showed no significant epithelial changes, although slight perivascular lymphocytic infiltration was seen in some biopsies.

Association of the composite IL-1 genotype with peri-implantitis: a systematic review

OBJECTIVE

Cytokine gene polymorphisms may modulate the host response to the bacterial challenge and influence susceptibility to peri-implantitis.

OBJECTIVE

To systematically review the evidence of an association between the interleukin-1 (IL-1) composite genotype, i.e. presence of the allele 2 in the gene clusters IL-1A (-889) and in IL-1B (+3953), and peri-implantitis.

MATERIAL AND METHODS

An electronic search in the National Library of Medicine-computerized bibliographic database MEDLINE and a manual search were performed. The search was conducted for longitudinal clinical trials comparing progression of peri-implantitis in IL-1 genotype positive (carrying allele 2) with IL-1 genotype negative (not carrying allele 2) subjects. Selection of publications, extraction of data and validity assessment were made independently by two reviewers.

RESULTS

The search provided 44 titles of which two longitudinal publications were included.

CONCLUSION

Based on the findings from this study, there is not enough evidence to support or refute an association between the IL-1 genotype status and peri-implantitis. Systematic genetic testing for the assessment of the risk of peri-implantitis cannot be recommended as a standard of care at this time.

Effect of Tumor Necrosis Factor-α Gene Polymorphism on Peri-Implant Bone Loss Following Prosthetic Reconstruction

PURPOSE

The present study investigates the association between a specific polymorphism in the tumor necrosis factor (TNF)-alpha gene, consisting of allele 2 of TNF-alpha-308, and peri-implant bone loss following prosthetic reconstruction.

MATERIALS AND METHODS

This case-control study included 36 patients (20 women, 16 men; mean age 46 years) who had used implant-supported prostheses for a minimum of 6 months and a maximum of 31 months. The patients were nonsmoking, white Caucasian Brazilians, in good general health, and were not receiving medication. In the case group, patients exhibited 1 or more implants with a diagnosis of peri-implant bone loss following prosthetic reconstruction; control patients had 1 or more healthy implants.

RESULTS

Polymorphism in the TNF-alpha gene, allele 2 of TNF-alpha, was not associated with an increased risk for peri-implant bone loss following prosthetic reconstruction (P=0.19; chi2=1.71; df=1), although 21.1% of the subjects carried allele in the control group 2, and 41.2% carried allele 2 in the case group.

CONCLUSIONS

Polymorphism in allele 2 of the TNF-alpha-308 gene is not associated with an increased risk for peri-implant bone loss following prosthetic reconstruction. However, further studies based on a greater number of patients are necessary.

Expression of interleukin 1-beta, transforming growth factor beta-1, and vascular endothelial growth factor in soft tissue over the implant before uncovering

BACKGROUND

Overexpression of inflammatory cytokines interleukin 1-beta (IL-1beta), transforming growth factor beta-1 (TGF-beta1), and vascular endothelial growth factor (VEGF) may cause healing impairment following implant insertion, jeopardizing success especially in patients previously irradiated. Limited data is available regarding expression pattern of inflammatory cytokines in peri-implant soft tissue caused by the surgical intervention itself.

STUDY DESIGN

This study examined 21 patients receiving dental implants. Biopsies of peri-implant tissue were harvested at re-entry 4 months after initial surgery. Eight patients underwent probing of untreated mucosa. Three groups were created (group 1: regular peri-implant mucosa; group 2: patients with irradiated peri-implant mucosa, radiation treatment due to oral squamous cell cancer; group 3: control). Immunohistochemical staining was performed for TGFss1, IL-1ss, and VEGF.

RESULTS

Following the placement of dental implants (group 1 vs group 3) a significant increase (P > .05) in TGF-beta1, IL-1beta, and VEGF expression in the peri-implant mucosa was demonstrated. No alteration of this distinct pattern was found for previously irradiated tissue (group 1 vs. group 2).

CONCLUSIONS

The study highlights the fundamental involvement of TGF-beta1, IL-1beta, and VEGF during the regeneration of peri-implant soft tissue structures. The use of extended interim solutions may be one clinical implication of these prolonged tissue remodeling processes.

Evaluation of the relationship between interleukin-1 gene cluster polymorphisms and early implant failure in non-smoking patients

OBJECTIVE

The aim of the present study was to investigate the relationship between specific polymorphisms of the interleukin-1 gene cluster and the early failure of osseointegrated implants.

MATERIAL AND METHODS

The subject population was composed by a test group comprising 28 non-smoking patients (mean age 52.7) that had suffered one or more early implant failures and by a control group consisting of 34 individuals (mean age 43.3) with one or more healthy implants. Genomic DNA from buccal mucosa was amplified by the polymerase chain reaction (PCR), followed by restriction fragment length polymorphism (RFLP) and submitted to polyacrylamide gel electrophoresis to distinguish the alleles of the interleukin-1A (-889), interleukin-1B (+3953), interleukin-1B (-511) and interleukin-RN (intron 2) gene polymorphisms. Differences in the allele and genotype frequencies between control and test groups were assessed by chi(2) test or by Monte Carlo simulations (P<0.05). Haplotype frequencies, linkage disequilibrium and Hardy-Weinberg equilibrium were also estimated.

RESULTS

No statistically significant differences were found in the genotype distribution or allelic frequencies of the polymorphisms. No differences were observed between control and test groups when different interleukin-1 gene cluster haplotypes were compared. Nevertheless, the interleukin-1A (-889) and interleukin-1B (+3953) polymorphic sites were in strong linkage disequilibrium (P=0.00014 for control group and P=0.0238 for the test group).

CONCLUSION

This study suggests that polymorphisms in the interleukin-1 gene cluster are not associated with early implant failure in a non-smoking Brazilian population.

Early Failure of Dental Implants and TNF-?? (G-308A) Gene Polymorphism

Tumor necrosis factor-alpha (TNF-alpha) is a potent inflammatory mediator with bone resorption activity. Polymorphisms in the promoter region of the human TNF-alpha gene have been shown to affect the levels of this cytokine and have been associated with a variety of diseases. The aim of this study was to investigate the possible relationship between early implant failure and a single nucleotide polymorphism (SNP) in the -308 promoter region of the TNF-alpha gene. A sample of 66 nonsmokers was divided into 2 groups: a test group comprising 28 patients (mean age, 52.7 years) with one or more early failed implants and a control group consisting of 38 individuals (mean age, 43.2 years) with one or more healthy implants. Genomic DNA from buccal mucosa was amplified by the polymerase chain reaction (PCR), analyzed by restriction fragment length polymorphism (RFLP), and submitted to polyacrylamide gel electrophoresis to distinguish allele G and allele A of the TNF-alpha (-308) gene polymorphism. Differences in the allele and genotype frequencies between control and test groups were assessed by chi-squared test (P <0.05). No significant difference was observed in the allele (P = 0.4635) and genotype (P = 0.4445) distribution of the polymorphism when control and failure groups were compared. The results indicate that the TNF-alpha (G-308A) gene polymorphism is not associated with early implant failure, suggesting that its presence alone does not constitute a genetic risk factor for implant loss in the Brazilian population.

Role of the osteoclast at the bone-implant interface

A thorough understanding of the processes of healing, repair, and remodeling of bone is critical for the establishment and maintenance of osseointegration of dental implants. In this regard, much attention has been paid to the anabolic aspects of bone remodeling, including the cell biology of the osteoblast and the various cytokines and growth factors which regulate these processes. In contrast, there is little information on the bone-resorptive activity that occurs around implants during osseointegration, and of the role of osteoclasts, macrophages, and stromal cells in those catabolic processes associated with bone remodeling. This paper reviews osteoclast cell biology, the interaction of osteoclasts and biomaterials, and the information available on osteoclasts and dental implants, and poses some questions for future research.

The effect on immunocytes of anodic oxide titanium after hydrothermal treatment

All dental root implants come in contact with the oral epithelium, and many complex factors are found to arise in this region. In order to perform a successful dental root implantation, it is necessary to clarify the interaction of the dental root implant material with the host defense mechanisms involved in the specific and nonspecific immune responses to many antigens in oral bacteria and their components. Recently, focusing on developing the dental root implant, the Nikon Corporation improved the surface characteristics of pure titanium even further by developing a hydroxyapatite (HA) layer formed on an anodic titanium oxide film containing Ca and P via hydrothermal treatment (SA treatment). However, since little is known about the effect of SA-treated pure titanium (HA/Ti) on the defense mechanisms of the oral membrane epithelium, we investigated (1) the in vitro proliferation of murine splenic B lymphocytes on the surface of HA/Ti in the presence of three lipopolysaccharide (LPS) concentrations and (2) interleukin-1alpha (IL-1alpha) production by the reaction of human peripheral blood mononuclear cells (PBM cells) on the surface of HA/Ti under the same concentrations. After culture, murine splenic lymphocytes were measured by uptake of 3H-thymidine, and cytokine release (IL-1alpha) from PBM cells was measured by ELISA. Results showed that HA/Ti had hardly any effect on the LPS-induced proliferation of B lymphocytes and IL-1alpha production. In vitro investigations of the effects of HA/Ti on the LPS-induced proliferation of murine splenic B lymphocytes and IL-1alpha from PBM cells might be a useful way of elucidating the defense mechanism between implants and the oral epithelium.

Mercury induces in vivo and in vitro secretion of interleukin-1 in mice

Macrophages from SJL and DBA mice incubated with mercuric chloride (HgCl2) in vitro for 24-72 h secreted an increased amount of interleukin 1 (IL-1) to the supernatant compared with control-incubated macrophages, as determined by a sensitive thymocyte proliferation assay. The increase of IL-1 activity showed a highly significant dose-response relationship, being close to that in controls at 10(-8) M, and maximal after incubation with 10(-5)-10(-6) M HgCl2 in both strains. At optimal concentrations of HgCl2 the IL-1 activity started to increase after 6 hrs incubation and reached a maximum after 48 h. Incubation with concentrations of HgCl2 higher than 10(-5) M resulted in a severely reduced IL-1 activity, which correlated with a reduced cell viability. Extracts of HgCl2-incubated macrophages representing cell-bound IL-1 showed no increase in IL-1 activity, irrespective of the concentration or incubation time. Topical application of HgCl2 in a mixture of acetone-olive oil on the external ear of SJL mice induced a dose- and time-dependent increase in IL-1 activity. A maximal increase was seen after application of 1% HgCl2 for 24 h with lower IL-1 activity after 48 and 72 h. Application of 5%, but not 1% or 0.1%, slightly increased the IL-1 activity in the contralateral ear treated with acetone-olive oil only, as compared with the activity in ears from animals given no mercury treatment, suggesting a systemic effect by application of 5% HgCl2.(ABSTRACT TRUNCATED AT 250 WORDS)